Basic Information
| Provider Information | |||||||||
| NPI: | 1871105874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JALLOH | ||||||||
| FirstName: | MARIAMA | ||||||||
| MiddleName: | RASHIDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9630 MILESTONE WAY APT 5121 | ||||||||
| Address2: | |||||||||
| City: | COLLEGE PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207404363 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 NEW JERSEY AVE SE STE 845 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200033338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025456980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN1007480 | DC | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.